Malnutrition is common in individuals with tuberculosis (TB), increasing the risk of TB infection or activating its latent form. Conversely, having TB worsens malnutrition by reducing appetite and food intake. Lao PDR has a high burden of TB, with an incidence of 138 per 100 000 in 2022. However, the prevalence of malnutrition among TB patients in the country was unknown, and nutritional assessment and support were not routinely provided at the point of TB care.
The National Tuberculosis Programme (NTP) in Lao PDR conducted the first national TB patient cost survey in 2018-2019. The survey identified the cost of additional foods or nutritional supplements as the major driver of catastrophic costs due to TB and recommended improving nutritional support for TB patients.
With funding and technical support from the WHO, the NTP, in close collaboration with the National Nutritional Centre, launched an implementation research project “Effect of nutritional intervention on TB treatment outcome and financial burden of TB: Before and after trial in Lao PDR” in March 2022 to examine the impact of nutritional intervention on TB treatment outcomes and the financial burden of TB. During the intervention period, the patients undergo systematic nutrition assessment and counselling by trained dieticians. Those identified as malnourished receive therapeutic and supplementary feeding. The study is being conducted in six central and provincial hospitals.
Preliminary results showed a high prevalence of malnutrition among TB patients at their diagnosis. Of the 290 participants, 41% were malnourished at the time, with a BMI of under 18.5. These findings underscore the urgent need for systematic nutritional assessment and counselling as integral components of TB care to identify and address malnutrition, thereby improving overall health outcomes for individuals with TB. The results from the study are expected to be finalized in the second quarter of 2024.
Globally, an estimated 2.2 million incident cases of TB were attributable to undernourishment, surpassing contributions from HIV infection, smoking and diabetes combined. Collaboration between TB and nutrition programmes and service integration will be vital to ending the TB epidemic.Acting WHO Representative Dr Yu Lee Park said: “This study has been instrumental in providing evidence to guide our ongoing efforts and to initiate policy dialogue on how TB and nutrition services can be integrated in the country. My heartfelt thanks to everyone involved in its development, and especially to the frontline healthcare workers dedicated to delivering essential healthcare services.”